Patient preferences and extended-release naltrexone: A new opportunity to treat opioid use disorders in Ukraine

Abstract

Background Scaling up HIV prevention for people who inject drugs (PWID) using opioid agonist therapies (OAT) in Ukraine has been restricted by individual and structural factors. Extended-release naltrexone (XR-NTX), however, provides new opportunities for treating opioid use disorders (OUDs) in this region, where both HIV incidence and mortality continue to increase. Methods Survey results from 1613 randomly selected PWID from 5 regions in Ukraine who were currently, previously or never on OAT were analyzed for their preference of pharmacological therapies for treating OUDs. For those preferring XR-NTX, independent correlates of their willingness to initiate XR-NTX were examined. Results Among the 1,613 PWID, 449 (27.8%) were interested in initiating XR-NTX. Independent correlates associated with interest in XR-NTX included: being from Mykolaiv (AOR=3.7, 95% CI= 2.3–6.1) or Dnipro (AOR=1.8, 95% CI=1.1–2.9); never having been on OAT (AOR=3.4, 95% CI=2.1–5.4); shorter-term injectors (AOR=0.9, 95% CI 0.9–0.98); and inversely for both positive (AOR=0.8, CI=0.8–0.9), and negative attitudes toward OAT (AOR=1.3, CI=1.2–1.4), respectively. Conclusions In the context of Eastern Europe and Central Asia where HIV is concentrated in PWID and where HIV prevention with OAT is under-scaled, new options for treating OUDs are urgently needed. Findings here suggest that XR-NTX could become an option for addiction treatment and HIV prevention especially for PWID who have shorter duration of injection and who harbor negative attitudes to OAT. Decision aids that inform patient preferences with accurate information about the various treatment options are likely to guide patients toward better, patient-centered treatments and improve treatment entry and retention.

A qualitative assessment of attitudes about and preferences for extended-release naltrexone, a new pharmacotherapy to treat opioid use disorders in Ukraine

“…To our knowledge this is the largest qualitative study of attitudes, beliefs, and preferences for OUD and acceptance of treatment initiation with XR-NTX. Findings here, in part, complement quantitative survey findings of patients' preferences for XR-NTX, which include never having been prescribed OAT previously, newer initiates to injection and expressing profoundly negative attitudes toward OAT (Marcus et al, 2017). These findings are crucial for the EECA context where treatment of OUD in Ukraine and other EECA countries has been restricted more by moral biases and prejudices than by scientific evidence and also greatly influenced by Russia where OAT is banned (Bojko et al, 2013; Cohen, 2010; Elovich & Drucker, 2008; Galeotti, 2016; Oakford, 2016; Samet, 2011).…”

Slow-release naltrexone implant versus oral naltrexone for improving treatment outcomes in people with HIV who are addicted to opioids: a double-blind, placebo-controlled, randomised trial

“…"addiction") is associated with suboptimal adherence to HIV treatment and poor outcomes (1). Methadone and buprenorphine maintenance improve these outcomes (2,3) but are not always available (4), illegal under Russian law even if used for detoxification, and some opioid addicted individuals prefer non-agonist treatment (5,6).…”

Factors influencing recruitment to a randomised placebo-controlled trial of oral naltrexone and extended release implant naltrexone: Qualitative study

“…Notably, these concerns do not appear to have influenced recruitment to trials of Probuphine®, a sustained-release buprenorphine implant (Ling et al, 2010;Rosenthal et al, 2013). Indeed, suspicion of implantable formulations seems to have received little attention outside of our own empirical qualitative research (Neale et al, 2018b), and appears to contrast with studies on the acceptability of injectable XR-NTX (Ahamad et al, 2015;Haase et al, 2016;Marcus et al, 2017;Marcus et al, 2018;Zaaijer et al, 2016). Given that the market of long-acting extended-release medications for OUD is expanding (Barnwal et al, 2017;Hegde, Singh & Sarkar, 2013;Lorman, 2018;Sigmon & Bigelow, 2016;Walsh et al, 2017), attitudes to such medications require further investigation, not least in light of concerns regarding the uptake of Probuphine® implants in the US (Titan Pharmaceuticals, 2018).…”